Provider Demographics
NPI:1285113241
Name:MCGOVERN, MOLLY (EDM, MA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:EDM, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4317
Mailing Address - Country:US
Mailing Address - Phone:914-275-7297
Mailing Address - Fax:
Practice Address - Street 1:69 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4317
Practice Address - Country:US
Practice Address - Phone:914-275-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist